Post on 27-Sep-2020
Advisory Panel on Improving Healthcare Systems
September 9, 2013 1−3 pm EST
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Welcome & Introductions
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Housekeeping
Today’s webinar is open to the public and is being recorded
Members of the public are invited to listen to this teleconference and view the webinar
Anyone may submit a comment through the webinar chat function, although no public comment period is scheduled
Visit www.pcori.org/events for more information
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Panel Leadership
Trent Haywood, MD, JD Advisory Panel Chair
Doris Lotz, MD, MPH Advisory Panel Co-Chair
Chad Boult, MD, MPH, MBA Director, PCORI Improving Healthcare Systems Program
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Advisory Panel Members
Andrew Adams, BBA MBA Candidate, The Wharton School of the University of Pennsylvania Leah Binder, MA, MGA President & CEO, The Leapfrog Group Mary Blegen, RN, MA, PhD, FAANAdjunct Professor, College of Nursing, University of Colorado at Denver David Bruhn, PharmD, MBA Health Outcomes Liaison, National Accounts, GlaxoSmithKline Daniel C. Cherkin, MS, PhD Director, Bastyr University Research Institute Senior Scientific Investigator, Group Health Research Institute Alan B. Cohen, MS, ScD Professor, Health Policy and Management, Boston University School of Management Elizabeth D. Cox, MD, PhD Associate Professor, Departments of Pediatrics and Population Health Sciences, University of Wisconsin-Madison Susan Diaz, MPAS, PA-C Physician Assistant, Liver Transplant, Mayo Clinic in Florida
John A. Galdo, PharmD, BCPS Clinical Pharmacy Educator, Barney’s Pharmacy Priscilla Huang, JD Policy Director, Asian & Pacific Islander American Health Forum (APIAHF) Eve A. Kerr, MD, MPH Director, Ann Arbor Center for Clinical Management Research Joan Leon, BA Retired Health Consultant Tiffany Leung, MD, MPH Internal Medicine Physician, Southern Illinois University Annie Lewis-O’Connor, NP-BC, MPH, PhD Founder and Director, Women’s CARE Clinic John Martin, MPH Senior Director, Research Operations, Premier Inc. Lisa Rossignol, MA Graduate Student, Health Communication, University of New Mexico Anne Sales, RN, PhD Professor, School of Nursing, University of Michigan Jamie Sullivan, MPHDirector of Public Policy, COPD Foundation Leonard Weather Jr., MD, RPH Director, Omni Fertility and Laser Institute
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IHS Staff
Lynn Disney, PhD, JD, MPH Senior Project Officer
Alex Hartzman, MPH, MPA Program Associate
Lauren Holuj, MHA Program Associate
Tomica Singleton Senior Administrative Assistant
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Today’s Discussion Topics
Improving Healthcare Systems Mission Portfolio
Initial Activities of the Advisory Panel and Staff Prioritization of Potential Research Topics Progress on Developing Prioritized Topics Discussion
Additional Roles for Advisory Panel Curriculum for Training Awardees Others
Adjourn
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Improving Healthcare Systems Program
Chad Boult, MD, MPH, MBA Director
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PCORI’s Mission
ACA 2010: PCORI shall fund comparative effectiveness research to Discover new information that allows
patients/families/clinicians and health system leaders to make better decisions between alternative approaches to care that may lead to better patient-centered outcomes
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Engagement
PCORI’s research must be conducted by scientists who are engaged with patients and stakeholders (like clinicians, executives of provider organizations, administrators of insurance companies, and representatives of manufacturers) Significant engagement extends throughout the research process
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Traditional Path for Selecting Topics for Research Contracts
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Novel Path for Selecting Topics for Research Contracts
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IHS Portfolio
From broad funding announcements 19 currently funded projects 13 new projects proposed for funding
From targeted funding announcements RCT of strategy for reducing serious injuries from falls in
older populations • June 14 - NIA-PCORI Falls Injuries Prevention Partnership
signed • July 16 - RFA released • August 23 - Informational webinar for applicants
• October 13 - LOIs are due • November 13 - Proposals due • February 2014 - Awardee to be announced
Five topics in development for funding announcements
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Initial Activities of the Advisory Panel and Staff
Trent Haywood, MD, JD – Panel Chair Doris Lotz, MD, MPH – Panel Co-Chair
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Evolution of the Topics
1,000+ research topics collected
841 accepted
309 assigned to Improving Healthcare Systems (IHS) program Program director screened and consolidated topics
90 were scored on four criteria
15 with highest scores were selected for further consideration
Topic briefs provided to Advisory Panelists Topics modified and prioritized by Advisory Panel (4/19/13)
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Prioritization of Topics
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Topic Score Rank Patient-Empowering Care
Management for Chronic Conditions 134 1
Transitions in Care 104 2 Mental Health and Primary Care
Co-Location 85 3
Perinatal Management 82 4 Effect of Insurance Features 78 5
Healthcare Homes 53 6 Health IT and Treatment Guidelines 52 7
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Progress on Prioritized Topics Chad Boult, MD, MPH, MBA – Program Director Lynn Disney, PhD, JD, MPH – Senior Program Officer Alex Hartzman, MPH, MPA – Program Associate Lauren Holuj, MHA – Program Associate
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Chad Boult, MD, MPH, MBA Program Director Lauren Holuj, MHA Program Associate
Hospital-to-Home Transitional Care Comparative effectiveness research to help guide the transformation of transitional care in the U.S.
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Goal
To facilitate informed decision making by policy makers, payers, hospitals, community agencies, physicians, patients, and caregivers that will guide the future implementation of transitional care models now being tested throughout the U.S.
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Development of the Topic
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PCORI Question Database
15 High Priority Topics
15 Topic Briefs
Commissioned
Advisory Panel April 19−20, 2013 Top Two Topics Expert Workgroup
July 12, 2013
1,000s of Topics
Submitted
CMS, BOOST, QIOs: Demo Data Collection
Commitments to Collaborate Research Explorations:
RAND, Westat, RTI Discussions with PDC:
7/23, 8/6, 8/20, 9/3
Transitional Care Models Being Tested
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The abilities of these models to reduce 30-day re-admissions are being tested in three national initiatives: Quality Improvement Organizations (QIOs) – 226 communities CMMI - Community-based Care Transitions Program (CCTP) – 102 communities SHM - Better Outcomes by Optimizing Safe Transitions (BOOST) – 183 hospitals
These demonstration projects will determine little about these models’ relative effects on other patient-centered or caregiver-centered outcomes, or about the models’ potential for scalability
Model Features CTI® TCM RED Duration 4 weeks 1−3 months 3−5 days Facilitator coach APN/RN virtual nurse In-hospital assessment + + + Pt preparation for discharge + + Pt personal health record + Medication management + + + Pt preparation for PCP visit + + Accompany pt to PCP visit + Post-discharge follow-up 3 phone calls 4 home visits, phone calls 1 phone call
Opportunity
Opportunity: Support a national comparative effectiveness study among the patients, caregivers, and other stakeholders who are participating in the ongoing demonstrations of various evidence-based models of transitional care
Examples of Possible Research Questions: What is the relative effectiveness of CTI®, TCM, and RED in improving patient- and
caregiver-centered outcomes (compared to “usual care”): • in urban/suburban people with complex transitional care needs? • in urban/suburban people with mental disabilities and complex transitional care needs? • in rural/frontier people with complex transitional care needs? • in rural/frontier people with mental disabilities and complex transitional care needs?
How acceptable is participation in CTI®, TCM, and RED for each of the participating stakeholders, e.g., hospitalists, primary care providers, coordinators, hospitals, and community agencies?
What are the effects of these models on other disadvantaged people, e.g., those with physical disability, low health literacy, low English literacy, no health insurance, poverty, non-supportive home environment, and/or lack of personal PCP?
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Research Contract
With the cooperation of CMS, Project BOOST, and the QIOs (which have already pledged their support), PCORI’s contractor would:
Develop and validate instruments Recruit patients, caregivers, providers, and organizations at a
sample of the 511 current demonstration sites Conduct surveys, interviews, and focus groups to determine:
• Model characteristics • Patient characteristics – demographics, complexity of care needs,
personal resources/challenges, etc. • Patient and caregiver outcomes 30 and 60 days post-discharge • Acceptability of the model to the relevant stakeholders
Analyze and report answers to research questions by 2017
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Potential to Improve Practice and Patient-Centered Outcomes
The results of this project would: Provide comprehensive information about the relative
benefits, harms, and acceptability of the CTI®, TCM, and RED models
Facilitate informed decision making by policy makers, payers, hospitals, community agencies, physicians, patients, and caregivers that would help guide the transformation of transitional care in the U.S.
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Discussion
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Patient-Empowering Care Management for Chronic Conditions
Alex Hartzman, MPH, MPA Program Associate
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Patient-Empowering Care Management Evolution of Topic
April 2013 - Advisory Panel combined 5 topics: • Care Management for Chronic Disease • Care Management for COPD • Care Management for Cancer • Care Management in Palliative Care • Care Management of Multiple Chronic Conditions
What is the effect of patient-empowering care management on patient-centered outcomes among patients with chronic or progressive conditions, disability, cancer, or other potentially life-changing illnesses? Workgroup scheduled for December 6, 2013
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Patient-Empowering Care Management Literature Reviews
Internal review found: A working definition of patient empowerment Confusion in the literature between use of the terms
empowerment, engagement, activation, enablement, etc. Good studies of models for some conditions (especially
diabetes, general chronic care) Very few measures of empowerment; most disease-specific
External advice against commissioning literature review: Literature base not specific enough on models, definition of
empowerment, specific process measures Ironically, best available literature reviews primarily
documented lack of agreement on meaning of the term.
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Patient-Empowering Care Management Typical Model Elements
Self-Determination Patients determine care goals with practitioners, record in
care plans Patient Education Patients are educated on diagnosis, treatment, and
management options, and their likely outcomes Motivational Interviewing Counseling to build patient confidence, self-efficacy, and trust
with care manager Care Management Training Training in the methods of care management for practitioners
to take on role
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Discussion
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Perinatal Care Management Lauren Holuj, MHA Program Associate
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Perinatal Care Management
What is the effect of care management on patient-centered outcomes among pregnant and post-partum women? Defining “perinatal” and evidence-based models Collaborating with PCORI’s Addressing Disparities
program Exploring the Strong Start for Mothers and Newborns
Initiative (CMMI) Multi-perspective workgroup to be held on October 24th
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Models of Integration of Mental Health Care and Primary Care Alex Hartzman, MPH, MPA Program Associate
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Integration of Mental Health Care and Primary Care Evolution of Topic
Compared to non-integrated care, what is the effect of primary care integrated with mental health care on mental health symptoms, medication use, and other patient-centered outcomes? Initial review of literature found:
• AHRQ has done a tremendous amount of work: Integrated Care Academy, Integrated Care Lexicon, What’s Needed in Research guide.
• A definition of care integration from AHRQ’s lexicon: “a set of working relationships and workflows between clinicians in separate spaces that achieves communication, collaboration, patient-centered operations, and practice culture.”
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Features of Health Insurance Coverage
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Lynn Disney, PhD, JD, MPH Senior Program Officer
Different Features of Health Insurance Topic Review and Progress Since Last Meeting
What are the relative effects of different insurance features (i.e., benefit designs, utilization management, cost sharing) on chronically ill patients’ access to care, quality of care, and PCOs? Is only addressed twice in PCORI’s portfolio Literature review on horizon Ideas on how to proceed?
• Magnitude of the topic • Cost of useful research • Sensitivities around cost-effectiveness research (which PCORI
may not fund)
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Discussion of Topics
Moderated by: Trent Haywood, MD, JD – Chair Doris Lotz, MD, MPH – Co-Chair
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Additional Roles for Advisory Panel
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Moderated by: Trent Haywood, MD, JD – Chair Doris Lotz, MD, MPH – Co-Chair
Curriculum for Training Awardees
To facilitate awardees’ success in PCORI research Online 1−2 hour course with different content for scientists, patients, and stakeholders Addresses knowledge, skill, and attitudinal learning objectives for each group Will be required for all PCORI awardees In development with education consultant Would benefit from input from Advisory Panel members
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Other Roles?
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Adjourn
Thank you for your participation!
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